P - 77721REQUEST FOR ELECTRICAL INSPECTIQ�2� �
1� 3 6 8� 0 8 0 Minnesota Board of Electricity .� (1
TJ ............
� 1821 University Avenue Suite S-128, S�u�Minnesota 55104
� (651) 642-0800 TTY/MRS 1-800-627-3529
" www.electriciry.state.mn.us
Identity the work covered by this request: �
❑NEW REMODEL ❑ADDITION ❑REPAIR ��� �D�� �� � 1 C ��
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIE TraHic Si nal Standard �$5
0 to 400 Am re �$25 D Su lementai Fee �$20
401 to 800 Am re �$50 Transformers u to 10 KVA (� $10
Above 800 Am re �$75 Transformers over 10 KVA �$20
CIRCUITS I FEEDERS Transfortner / Power Su I tor Si ns / Outline Li htln �$5
0 to 200 Am re �$5 ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re�$10 Includes the Service andlor Power Supply up to 500 Amperes, All
ALARM, CAMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Tri Each Dwellin Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ion Tri s�$20
Each S stem Device or aratus �$.50 Investiqative Pee C.��
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UN
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25
OTHER ADDITIONAL FEES
Li htin Retrofit �$25 r Fixture
Center Pivot Irri ation Boom �$40
Manufactured Home Park Lots � $25
Recreational Vehicle Park Sites � $5
Se arate Bondin Ins 'on � $20
S ial Ins �on �$30 r Hour
S ial In ' n�$.31 r Mile
THIS INSTALLATION MAY BE ORD
wn
FOR OFFICE USE ONLY
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total fee is
that I insoected the electrical insfalla6on
�r
dates stated: I
/�' lL`tj I
fED WITHIN 18 MONTHS
N�f � �_ �j �"e,l �
Request ate: Rough-in Inspection Required? ❑ Yes �No Inspection Omer Than Rou h-In:
2 g ❑ Ready Now Will Call
! 7 � l0 � You must call Me inspector when ready! Date Ready:
I certi(y that I am the �ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address (S eet, Box, or Route No.) Ciry Zi Code
S7� U.c4-��" f 1i1 n e r.sz �c�f�c�.e. r, ��-; �Q 1� P S S 4� 3�.
Section Township Range Fire No. County a �r�-
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Occupant Phone
/Ca,`�-'�, La�w Z..tL �r- �� 3 S 7� �d ��
Power Supplier Address
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Electrical Contrador / Company Name Contractor License Number Master License umber
e s d.�p r� ��.Q ��� � c�i� c, C,l� 9�$' `� % A� ►n c� �' 3 z Z
Mailing Address (Contrador, Company or Owner Perfo mg Installation) �
3 a� T�t K; (� -er s�-� i�,a �.`f o i�vl�.2 cQ �/1i Al 5S/ I�
Authorized Signa�Co�iactor, Coryipany or Own Perfo ing Installation) Phone � � 3����
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EB-00001A-13 7/1/2000 BOARD OF ELECTNICfTY COPY INSTRUCTIpNS ON BACK OF YELLOW COPY